Elder Abuse

Elder maltreatment is a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person.

This type of violence constitutes a violation of human rights and includes

physical, sexual, psychological, emotional; financial and material abuse; abandonment; neglect; and serious loss of dignity and respect.

Who Is Being Abused

The US has:  44 million persons age 60+.  36 million people with disabilities. 364,512 cases of people living at home were reported with 43% confirmed. In the last 10 years abuse of elder persons has increases 150+%. Domestic Elder Abuse is a family problem, almost 90% of the abusers were family members.

Around 4-6% of elderly people have experienced some form of maltreatment at home. Elder maltreatment can lead to serious physical injuries and long-term psychological consequences. Elder maltreatment is predicted to increase as many countries are experiencing rapidly ageing populations.

Who Are The Abusers

More than 2/3rds of the abusers are family members of the victims and are typically serving in the care-giving role.

Risk Factors

Domestic Violence grown old.

A partnership in which one member of the couple has traditionally exerted power and control over the other through emotional abuse, physical violence and threats, isolation and other tactics.

Risk Factors - Continued

Personal problems of the abusers.

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Adult children who are still dependent upon parent for financial assistance, housing or other means of support. Mental Illness. Substance Abuse.

Risk Factors - Continued
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Caregiver stress. Cycle of violence is learned behavior transmitted from one generation to the next. Personal characteristics of the elder.
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Dementia. Disruptive behavior. Problematic personality traits. Significant needs of assistance.

Domestic Elder Abuse

Domestic Abuse Grown Old.

Maltreatment of an older person by someone who has a special relationship with the elder. (e.g. spouse, sibling, child, friend, caregiver). Spouses make up a large % of elder abusers. Partnerships in which one member of a couple has traditionally tried to exert power and control over the other.

Institutional Elder Abuse

Abuse that occurs in residential facilities for older persons. (e.g. nursing homes, foster homes, group homes, board and care facilities. Abusers are persons who have legal or contractual obligation to provide elder victims with care and protection. (e.g. staff, professionals, paid caregivers).

Case 1

Jonathan Aquino, was sentenced 18 months in prison in London after hitting an 80-year-old woman in his care The footage showed Aquino striking Maria Worroll, who has Alzheimer's disease, in the face, arms, and abdomen.

Self-neglect – Self-abuse

Self Neglect is behavior of an elderly person that threatens his/her own health/safety.

*Self-neglect EXCLUDES a situation in which a mentally competent person who understands the consequences of his/her decisions, makes a conscious and voluntary decision to engage in acts that threaten his/her safety as a matter of personal choice.

Signs of Self-Neglect
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Dehydration, malnutrition Untreated medical conditions Lack of necessary medical aids Hazardous or unsafe living conditions Unsanitary or unclean living quarters Inappropriate and/or inadequate clothing Homelessness

Physical Abuse

Physical force that may result in bodily injury, physical pain or impairment. Striking with or without an object.

Signs of Physical Abuse
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Bruises, black eyes, welts, lacerations. Rope/restraint marks. Open wounds, cuts, punctures, untreated injuries in various stages of healing. Sprains, dislocations, internal injuries.

Signs of Physical Abuse –

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Laboratory findings of medication overdose. An elder’s report of being hit, slapped kicked or mistreated. An elder’s sudden change in behavior. The caregiver’s refusal to allow visitors to see and elder alone.

Sexual Abuse

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Sexual abuse is non consensual sexual contact of any kind with an elderly person. It includes unwanted touching Sexual assault or battery such as rape, sodomy, coerced nudity and sexually explicit photographing.

Signs of Sexual Abuse
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Bruises around breasts or genital area. Unexplained venereal disease or genital infections. Unexplained vaginal or anal bleeding. Torn, stained, or bloody underclothing. An elder’s report of being sexually assaulted or raped.

Emotional or Psychological Abuse

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The infliction of anguish, pain, or distress through verbal or nonverbal acts. Includes, verbal assaults, insults, threats, intimidation, humiliation, harassment Treating the older person like an infant Isolating an elderly person from his/her family, friends or regular activities. Giving an older person the “silent treatment” or enforced social isolation.

Signs of Emotional/Psychological Abuse
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Emotionally upset or agitated Extremely withdrawn Non-communicative or non-responsive Unusual behavior usually attributed to ―dementia‖ (e.g. sucking, biting, rocking)

Neglect

The refusal or failure to fulfill any part of a person’s obligations or duties to an elder. Failure of a person who has fiduciary responsibilities to provide for an elder. Failure to provide an elderly person with necessities, food water, clothing, shelter, personal hygiene, medicine, comfort, personal safety.

Abandonment

The desertion of an elderly person by an individual who has assumed the responsibility for providing care to the elder, or by the person who has physical custody of the elder.

Financial or Material Exploitation

The illegal or improper use of an elder’s funds, property, or assets.

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Cashing an elder’s checks without authorization or permission. Forging an elder’s signature, Misusing or stealing an elder’s money or possessions, Coercing or deceiving an elder into signing any document, (contracts or wills). Improper use of guardianship or power of attorney.

Signs of Financial or Material Exploitation.

Sudden changes in bank account or banking practice. Inclusion of additional names on a bank signature card. Unauthorized banking, remaking of wills, advanced directives, or other legal matters of any kind.

Socio-cultural
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depiction of older people as frail, weak and dependent; erosion of the bonds between generations of a family; systems of inheritance and land rights, affecting the distribution of power and material goods within families;

migration of young couples, leaving elderly parents alone, in societies where older people were traditionally cared for by their offspring; lack of funds to pay for care.

Within institutions, maltreatment is more likely to occur where:

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standards for health care, welfare services and care facilities for elder persons are low where staff are poorly trained, remunerated, and overworked where the physical environment is deficient where policies operate in the interests of the institution rather than the residents.

Prevention

public and professional awareness campaigns, screening (of potential victims and abusers) caregiver support interventions (e.g. stress management) caregiver training on dementia. efforts to respond to and prevent further maltreatment include interventions such as:

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screening potential victims mandatory reporting of maltreatment to authorities adult protective services home visitation by police and social workers self-help groups safe-houses and emergency shelters caregiver support interventions.

SENIOR NUTRITION: FEEDING THE BODY, MIND AND SOUL

How many calories do seniors need?
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A woman over 50 who is: Not physically active needs about 1600 calories a day Somewhat physically active needs about 1800 calories a day Very active needs about 2000 calories a day

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A man over 50 who is: Not physically active needs about 2000 calories a day Somewhat physically active needs about 2200-2400 calories a day Very active needs about 2400-2800 calories a day
Source: National Institute of

Aging

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Bread and Cereal = 6-11 servings Vegetables = 3-5 servings Fruits = 2-4 servings Milk, Yogurt, Cheese = 2-3 Servings Meat, Fish, Poultry = 2-3 Servings Fats, Oils, & Sweets = use

Senior food pyramid guidelines

Fruit – Focus on whole fruits rather than juices for more fiber and vitamins and aim for around 1 ½ to 2 servings each day. Break the apple and banana rut and go for color-rich pickings like berries or melons.

Veggies – Choose antioxidant-rich dark, leafy greens, such as kale, spinach, and broccoli as well as orange and yellow vegetables, such as carrots, squash, and yams. Try for 2 to 2 ½ cups of veggies every day.

Calcium – Maintaining bone health as you age depends on adequate calcium intake to prevent osteoporosis and bone fractures. Seniors need 1,200 mg of calcium a day through servings of milk, yogurt, or cheese. Non-dairy sources include tofu, broccoli, almonds, and kale. Grains – choose whole grains over processed white flour for more nutrients and more fiber. If you’re not sure, look for pasta, breads, and cereals that list ―whole‖ in the ingredient list. Seniors need 6-7 ounces of grains each day (one ounce is about 1 slice of bread).

Protein – Seniors need about 0.5 grams per pound of bodyweight. Simply divide your bodyweight in half to know how many grams you need. A 130pound woman will need around 65 grams of protein a day. A serving of tuna, for example, has about 40 grams of protein. Vary your sources with more fish, beans, peas, nuts, eggs, milk, cheese, and seeds.

Water – Seniors are prone to dehydration because our bodies lose some of the ability to regulate fluid levels and our sense of thirst is dulled as we age. Post a note in your kitchen reminding you to sip water every hour and with meals to avoid urinary tract infections, constipation, and even confusion.

Vitamin B – After 50, your stomach produces less gastric acid making it difficult to absorb vitamin B-12—needed to help keep blood and nerves vital. Get the recommended daily intake (2.4 mcg) of B12 from fortified foods or a vitamin supplement.

Vitamin D – We get most of our vitamin D intake—essential to absorbing calcium—through sun exposure and certain foods (fatty fish, egg yolk, and fortified milk). With age, our skin is less efficient at synthesizing vitamin D, so consult your doctor about supplementing your diet with fortified foods or a multivitamin.

Senior nutrition: Tips for creating a well-balanced diet

Avoid skipping meals – This causes your metabolism to slow down, which leads to feeling sluggish and making poorer choices later in the day.

Breakfast – Select high-fiber breads and cereals, colorful fruit, and protein to fill you with energy for the day. Try yogurt with muesli and berries, a veggie-packed omelet, peanut-butter on whole grain toast with a citrus salad, or old-fashioned oatmeal made with dried cherries, walnuts, and honey.

Lunch – Keep your body fueled for the afternoon with a variety of whole-grain breads, lean protein, and fiber.

Dinner – End the day on a wholesome note. Try warm salads of roasted veggies and a side of crusty brown bread and cheese, grilled salmon with spicy salsa, or whole-wheat pasta with asparagus and shrimp. Opt for sweet potatoes instead of white potatoes and grilled meat instead of fried. Snacks - It’s okay, even recommended, to snack. But make sure you make it count by choosing high-fiber snacks to healthfully tide you over to your next meal. Choose almonds and raisins instead of chips, and fruit instead of sweets. Other smart snacks include yogurt, cottage cheese, apples and peanut butter, and veggies.

Senior nutrition: Overcoming obstacles to healthy eating
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Say “no” to eating alone Eating with others can be as important as adding vitamins to your diet. A social atmosphere stimulates your mind and helps you enjoy meals. When you enjoy mealtimes, you’re more likely to eat better. If you live alone, eating with company will take some strategizing, but the effort will pay off.

Make a date to share lunch or dinners with grandchildren, nieces, nephews, friends, and neighbors on a rotating basis. Join in by taking a class, volunteering, or going on an outing, all of which can lead to new friendships and dining buddies.

Adult day care centers provide both companionship and nutritious meals for seniors who are isolated and lonely, or unable to prepare their own meals. Senior meal programs are a great way to meet others.

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Loss of appetite First, check with your doctor to see if your loss of appetite could be due to medication you're taking, and whether the medication or dosage can be changed. Try natural flavor enhancers such as olive oil, vinegar, garlic, onions, ginger, and spices to boost your appetite.

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Difficulty chewing Make chewing easier by drinking smoothies made with fresh fruit, yogurt, and protein powder. Eat steamed veggies and soft food such as couscous, rice, and yogurt. Consult your dentist to make sure your dentures are properly fitted.

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Dry mouth Drink 8 -10 glasses of water each day. Take a drink of water after each bite of food, add sauces and salsas to your food to moisten it, avoid commercial mouthwash, and ask your doctor about artificial saliva products.

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